No Quick Fix.

          The Minister of Health intends to reverse the decision previously taken by the government to allow generic drug-makers to produce their own version of Oxycontin.  A powerful narcotic, Oxycontin is a major agent of prescription  drug addiction.    During most of my years of clinical practice, physicians who prescribed narcotics in the abundance that many do today would have been  under investigation by the RCMP.  Some would have been restricted in their prescribing   Recurrent offenders may have been prohibited from prescribing narcotics altogether.  The most serious offenders sometimes had their license suspended or even revoked.  According the Minister, Canada had 401,000 people abusing prescription drugs in 2012 and is probably the worlds largest user of opioids on  a per capita basis.  "Research shows that of the kids who abused opioids, seventy per cent said they got it at home."
            There were always doctors who over-prescribed and I have previously described how a nurse informed me that her niece with an infected hang-nail was prescribed Oxycontin tablets 30 as well as the antibiotic.  She didn't need the  prescription  and  she didn't fill  it.  She took a couple of Tylenol, and gained satisfactory relief.  
             When did this over prescribing pattern become so pervasive?  And why?
             My guess is that the problem which was always there gained much momentum over the past ten years or so and coincided with  a philosophy of demanding  instant gratification on the part of some patients and the reluctance of many physicians  to defy the patients demands even when it is not the best solution to the problem.   Drug seeking patients can get very abusive when denied what they feel they need.  It is easier to write a prescription than get into a harangue with a patient in a busy office practice.  It can take time to convince a patient that your treatment plan is better than theirs.  Political correctness ordains that everyone's opinion is equal.  Of course no patient should be left in pain if it can be relieved, but that doesn't mean that narcotics are called for    When  I  was concerned about addiction patterns developing in some patients and consulted with specialists from  Pain  Clinics, the patient often came back on  heavier doses of narcotics than they had been on before.   General attitudes about drug abuse have changed, including the attitudes of the College of Physicians and Surgeons making  it difficult for those physicians who prescribe more selectively.
              Prescribing patterns have to  be reviewed and use of narcotics has to be better controlled.  Rules for narcotic use have to be clearly defined.  Rules, not guidelines.   Unfortunately, as always, the hard-working appropriately prescribing physicians will be caught up in this, as they always are.  But, then no good deed ever goes unpunished!